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Annam A, Alexander ES, Cahill AM, Foley D, Green J, Himes EA, Johnson DT, Josephs S, Kulungowski AM, Leonard JC, Nance ML, Patel S, Pezeshkmehr A, Riggle K. Society of Interventional Radiology Position Statement on Endovascular Trauma Intervention in the Pediatric Population. J Vasc Interv Radiol 2024:S1051-0443(24)00274-4. [PMID: 38631607 DOI: 10.1016/j.jvir.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Aparna Annam
- Children's Hospital Colorado, 13123 East 16(th) Ave., Aurora, CO 80045.
| | - Erica S Alexander
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065.
| | - Anne Marie Cahill
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd.Philadelphia, PA 19104.
| | - David Foley
- University of Louisville, Norton Children's Hospital, 231 E. Chestnut St., Louisville, KY 40202.
| | - Jared Green
- Envision Radiology Associates of Hollywood, 500 N Hiatus Rd. Suite 200, Pembroke Pines, FL 33026.
| | - Elizabeth A Himes
- Society of Interventional Radiology, 3975 Fair Ridge Dr. Suite 400N, Fairfax, VA 22033.
| | - D Thor Johnson
- Radiology Alliance, 210 25th Avenue South Suite 1204, Nashville, TN 37203.
| | - Shellie Josephs
- Texas Children's Hospital Austin, 9935 N. Lake Creek Pkwy., Austin, TX 78717.
| | - Ann M Kulungowski
- Children's Hospital Colorado, 13123 East 16th Ave. Box B323, Aurora, CO 80045.
| | - Julie C Leonard
- Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205.
| | - Michael L Nance
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104.
| | | | - Amir Pezeshkmehr
- Texas Children's Hospital, 6701 Fannin St., Unit 470, Houston, TX 77030.
| | - Kevin Riggle
- University of Louisville, Norton Children's Hospital, 231 E. Chestnut St., Louisville, KY 40202.
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Harding E, Hill LR, Black JO, Annam A, Wright CJ. Term Neonate with Progressive Respiratory Distress. J Pediatr 2023; 263:113704. [PMID: 37640231 DOI: 10.1016/j.jpeds.2023.113704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Emma Harding
- Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Lauren R Hill
- Vascular Anomalies Center, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
| | - Jennifer O Black
- Department of Pathology, Children's Hospital Colorado, Aurora, Colorado
| | - Aparna Annam
- Vascular Anomalies Center and, Department of Pediatric Radiology, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
| | - Clyde J Wright
- Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, Colorado
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Josephs S, Keller EJ, Vadlamudi V, Annam A, Abi-Jaoudeh N. Subspecialty Training in IR. J Vasc Interv Radiol 2023; 34:2074-2075. [PMID: 38008541 DOI: 10.1016/j.jvir.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/13/2023] [Indexed: 11/28/2023] Open
Affiliation(s)
- Shellie Josephs
- Division of Pediatric Interventional Radiology, Texas Children's Medical Center, Houston, Texas.
| | - Eric J Keller
- Division of Interventional Radiology, Stanford University, Stanford, California
| | - Venu Vadlamudi
- Vascular/Interventional Radiology and Neurointerventional Surgery, Beacon Medical Group South Bend, Indiana; Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Aparna Annam
- Division of Pediatric Interventional Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - Nadine Abi-Jaoudeh
- Division of Interventional Radiology, University of California-Irvine, Irvine, California
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Temple MJ, Abruzzo TA, Muñoz FG, Amaral JG, Bogan KA, Gibson C, Patel PA, Toh LM, Zhang J, Mubarak WM, Connolly BL, Mitchell SE, Barnacle AM, Cahill AM, Braswell LE, Marshalleck FE, Patel MN, Feola GP, Chaudry GA, Chennapragada SM, Josephs SC, Annam A, Goman SK. Fostering research in pediatric interventional radiology: needs assessment and suggestions for support. Pediatr Radiol 2023; 53:2245-2252. [PMID: 37568041 DOI: 10.1007/s00247-023-05722-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Due to the rarity of pediatric diseases, collaborative research is the key to maximizing the impact of research studies. A research needs assessment survey was created to support initiatives to foster pediatric interventional radiology research. OBJECTIVE To assess the status of pediatric interventional radiology research, identify perceived barriers, obtain community input on areas of research/education/support, and create metrics for evaluating changes/responses to programmatic initiatives. MATERIALS AND METHODS A survey link was sent to approximately 275 members of the Society for Pediatric Interventional Radiology (SPIR) between May and October 2020. Data was collected using a web-based interface. Data collected included practice setting, clinical role, research experience, research barriers, and suggestions for future initiatives. RESULTS Fifty-nine surveys were analyzed with a staff physician survey response rate of 28% (56/198). A wide range of practice sizes from 15 countries were represented. Respondents were predominantly staff physicians (95%; 56/59) with an average of 11 years (range: 1-25 years) of clinical experience working at academic or freestanding children's hospitals. A total of 100% (59/59) had research experience, and 70% (41/58) had published research with a mean of 30 peer-reviewed publications (range: 1-200). For job security, 56% (33/59) of respondents were expected or required to publish, but only 19% (11/58) had research support staff, and 42% (25/59) had protected research time, but of those, 36% (9/25) got the time "sometimes or never." Lack of support staff, established collaborative processes, and education were identified as top barriers to performing research. CONCLUSIONS The needs assessment survey demonstrated active research output despite several identified barriers. There is a widespread interest within the pediatric interventional radiology community for collaborative research.
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Affiliation(s)
- Michael J Temple
- Hospital for Sick Children, Toronto, ON, Canada.
- St. Jude Children's Research Hospital, Memphis, TN, USA.
| | | | | | | | | | - Craig Gibson
- Perth Children's Hospital, Nedlands, WA, Australia
| | - Premal A Patel
- Great Ormond Street Hospital for Sick Children, London, UK
| | - Luke M Toh
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Jin Zhang
- Guangdong Provincial Peoples' Hospital, Guangzhou, Guangdong Province, China
| | | | | | | | | | | | | | | | | | - G Peter Feola
- Primary Children's Hospital, Salt Lake City, UT, USA
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Bent Robinson E, Casadaban L, Neves Da Silva H, Annam A, Lindquist J, Rochon P. Abstract No. 510 Retrospective Analysis of Recanalization Rates Using Non-Fibered Coils for Pulmonary Arteriovenous Malformation Occlusion. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Robinson EB, Jordan G, Katz D, Sundaram SS, Boster J, Brigham D, Ladd P, Chan CM, Shay RL, Ochmanek E, Annam A. Congenital Portosystemic Shunts: Variable Clinical Presentations Requiring a Tailored Endovascular or Surgical Approach. JPGN Rep 2023; 4:e279. [PMID: 37181921 PMCID: PMC10174742 DOI: 10.1097/pg9.0000000000000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/21/2022] [Indexed: 05/16/2023]
Abstract
Congenital portosystemic shunts (CPSS) are rare developmental anomalies resulting in diversion of portal flow to the systemic circulation. These shunts allow intestinal blood to reach the systemic circulation directly, and if persistent or large, may lead to long-term complications. CPSS can have a variety of clinical presentations that depend on the substrate that is bypassing hepatic metabolism or the degree of hypoperfusion of the liver. Many intrahepatic shunts spontaneously close by 1 year of age, but extrahepatic and persistent intrahepatic shunts require intervention by a single session or staged closure with a multidisciplinary approach. Early detection and appropriate management are important for a good prognosis. The aim of this case series is to describe the varied clinical presentations, treatment approaches, and outcomes of 5 children with CPSS at our institution. Management of these patients should involve a multidisciplinary team, including interventional radiology, surgery, hepatology, and other medical services as the patient's clinical presentation warrants. Regardless of clinical presentation, if a CPSS persists past 1-2 years of age, closure is recommended.
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Affiliation(s)
- Eduardo Bent Robinson
- From the Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory Jordan
- From the Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Danielle Katz
- Division of Pediatric Radiology, Department of Radiology, University of Colorado, Aurora, CO, USA
| | - Shikha S. Sundaram
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Julia Boster
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Dania Brigham
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Patricia Ladd
- Division of Pediatric Radiology, Department of Radiology, University of Colorado, Aurora, CO, USA
| | - Christine M. Chan
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Rebecca L. Shay
- Division of Neonatology, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Emily Ochmanek
- Division of Interventional Radiology, Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Aparna Annam
- Division of Pediatric Radiology, Department of Radiology, University of Colorado, Aurora, CO, USA
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Stewart DL, Elsayed Y, Fraga MV, Coley BD, Annam A, Milla SS. Use of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes. Pediatrics 2022; 150:190110. [PMID: 37154781 DOI: 10.1542/peds.2022-060053] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) refers to the use of portable imaging performed by the provider clinician at the bedside for diagnostic, therapeutic, and procedural purposes. POCUS could be considered an extension of the physical examination but not a substitute for diagnostic imaging. Use of POCUS in emergency situations can be lifesaving in the NICU if performed in a timely fashion for cardiac tamponade, pleural effusions, pneumothorax, etc, with potential for enhancing quality of care and improving outcomes.
In the past 2 decades, POCUS has gained significant acceptance in clinical medicine in many parts of the world and in many subspecialties. Formal accredited training and certification programs are available for neonatology trainees as well as for many other subspecialties in Canada, Australia, and New Zealand. Although no formal training program or certification is available to neonatologists in Europe, POCUS is widely available to providers in NICUs. A formal institutional POCUS fellowship is now available in Canada. In the United States, many clinicians have the skills to perform POCUS and have incorporated it in their daily clinical practice. However, appropriate equipment remains limited, and many barriers exist to POCUS program implementation.
Recently, the first international evidence-based POCUS guidelines for use in neonatology and pediatric critical care were published. Considering the potential benefits, a recent national survey of neonatologists confirmed that the majority of clinicians were inclined to adopt POCUS in their clinical practice if the barriers could be resolved.
This technical report describes many potential POCUS applications in the NICU for diagnostic and procedural purposes.
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Affiliation(s)
- Dan L Stewart
- Department of Pediatrics and International Pediatrics, Norton Children's Neonatology Affiliated with University of Louisville School of Medicine, Louisville, Kentucky
| | - Yasser Elsayed
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba-Canada, Health Sciences Centre-Winnipeg, Winnipeg, Manitoba, Canada
| | - María V Fraga
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brian D Coley
- Departments of Radiology and Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aparna Annam
- Departments of Radiology and Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Vascular Anomalies Center, Aurora, Colorado
| | - Sarah Sarvis Milla
- Departments of Radiology and Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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Nakano TA, Rankin AW, Annam A, Kulungowski AM, McCallen LM, Hill LR, Chatfield KC. Trametinib for Refractory Chylous Effusions and Systemic Complications in Children with Noonan Syndrome. J Pediatr 2022; 248:81-88.e1. [PMID: 35605646 DOI: 10.1016/j.jpeds.2022.05.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the effect of the RAS-MAPK pathway inhibitor trametinib on medically refractory chylous effusions in 3 hospitalized patients with Noonan syndrome. STUDY DESIGN Pharmacologic MEK1/2 inhibition has been used to treat conditions associated with Noonan syndrome, given that activation of RAS-MAPK pathway variants leads to downstream MEK activation. We describe our experience with 3 patients with Noonan syndrome (owing to variants in 3 distinct genes) and refractory chylous effusions treated successfully with MEK inhibition. A monitoring protocol was established to standardize medication dosing and monitoring of outcome measures. RESULTS Subjects demonstrated improvement in lymphatic leak with additional findings of improved growth and normalization of cardiac and hematologic measurements. Trametinib was administered safely, with only moderate skin irritation in 1 subject. CONCLUSIONS Improvements in a variety of quantifiable measurements highlight the potential utility of MEK1/2 inhibition in patients with Noonan syndrome and life-threatening lymphatic disease. Larger, prospective studies are needed to confirm efficacy and assess long-term safety.
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Affiliation(s)
- Taizo A Nakano
- Vascular Anomalies Center, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO; Center for Cancer and Blood Disorders, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO
| | - Alexander W Rankin
- Center for Cancer and Blood Disorders, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO
| | - Aparna Annam
- Vascular Anomalies Center, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO; Department of Pediatric Radiology, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO
| | - Ann M Kulungowski
- Vascular Anomalies Center, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO; Department of Pediatric Surgery, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO
| | - Leslie M McCallen
- Vascular Anomalies Center, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO
| | - Lauren R Hill
- Vascular Anomalies Center, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO
| | - Kathryn C Chatfield
- Vascular Anomalies Center, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO.
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Annam A, Josephs S, Johnson T, Kulungowski AM, Towbin RB, Cahill AM. Pediatric trauma and the role of the interventional radiologist. Emerg Radiol 2022; 29:903-914. [PMID: 35678950 DOI: 10.1007/s10140-022-02067-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE While interventional radiologists occupy a critical role in adult trauma management, the role of interventionalist in pediatric trauma continues to evolve. The indications for transarterial embolization (TAE) are significantly different in pediatric patients in whom non-operative management (NOM) has a much more prominent role than in adults. Contrast extravasation on imaging may not require acute surgical or interventional management as it would in an adult. There are also areas in which pediatric interventional radiology is increasingly useful such as pelvic TAE in failed management, or splenic embolization to treat bleeding without the loss of splenic function inherent to surgical splenectomy. The rapid evolution of techniques and devices in pediatric patients is also changing what interventions are possible in pediatric trauma management which necessitates frequent reassessment of the guidelines and interventional radiology's role in caring for these patients. CONCLUSION This review seeks to consolidate the recent literature to describe the evolving role of the interventional radiologist in pediatric trauma management.
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Affiliation(s)
- Aparna Annam
- Division of Pediatric Radiology, Department of Radiology, University of Colorado, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
| | - Shellie Josephs
- Department of Pediatric Radiology, Lucile Packard Children's Hospital, Stanford Medicine, Palo Alto, CA, USA
| | - Thor Johnson
- Division of Vascular and Interventional Radiology, Medical University of South Carolina, Mount Pleasant, SC, USA
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Department of Surgery, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Richard B Towbin
- Emeritus Radiologist-in-Chief at Phoenix Children's Hospital, Phoenix, USA
| | - Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Huang J, Yoeli D, Sundaram SS, Carpenter T, Annam A, Pahlavan S, Wachs M, Adams MA. Extracorporeal membrane oxygenation as rescue therapy in a pediatric liver transplant recipient with very severe hepatopulmonary syndrome. Pediatr Transplant 2022; 26:e14185. [PMID: 34741368 DOI: 10.1111/petr.14185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In children with cirrhosis, the prevalence of HPS ranges from 3% to 20%, resulting in impaired gas exchange due to alterations in pulmonary microvasculature. LT is the gold-standard cure for cirrhosis complicated by HPS and should ideally be performed prior to the development of severe HPS due to increased risk for post-transplant hypoxia, right heart failure, and outflow obstruction. METHODS We present a case of a 13-year-old man, who underwent pediatric LT for severe HPS complicated by postoperative respiratory collapse, requiring a 92-day course of veno-venous ECMO. RESULTS Post-transplant, despite BiPAP, inhaled nitric oxide and isoproterenol infusion, he remained hypoxic postoperatively and acutely decompensated on postoperative day 25, requiring veno-venous ECMO. After 84 days on ECMO, a persistent large splenorenal shunt was identified that was embolized by interventional radiology, and 8 days after shunt embolization and ASD closure, he was successfully weaned off ECMO. CONCLUSIONS This case describes the longest known duration of ECMO in a pediatric LT recipient and a unique improvement in hypoxemia following a portosystemic shunt closure. ECMO presents a heroic rescue measure for pediatric LT recipients with HPS that develops acute respiratory failure postoperatively refractory to alternative measures.
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Affiliation(s)
- Joy Huang
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Dor Yoeli
- Division of Transplant Surgery, Colorado Center for Transplantation Care, Research and Education, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Shikha S Sundaram
- Section of Gastroenterology, Hepatology, and Nutrition, Digestive Health Institute, University of Colorado Denver School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Todd Carpenter
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Aparna Annam
- Division of Pediatric Radiology, Department of Radiology, University of Colorado and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Sheila Pahlavan
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael Wachs
- Colorado Center for Transplantation Care, Research and Education, Division of Transplant Surgery, University of Colorado Denver School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Megan A Adams
- Colorado Center for Transplantation Care, Research and Education, Division of Transplant Surgery, University of Colorado Denver School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
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Shay RL, Goldberg A, Sundaram SS, Browne LP, Wright CJ, Annam A. Neonatal Presentation of Congenital Portosystemic Shunt. J Pediatr 2022; 241:261-262. [PMID: 34687689 PMCID: PMC8923355 DOI: 10.1016/j.jpeds.2021.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/13/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Rebecca L. Shay
- Department of Pediatrics, University of Colorado Hospital, Section of Neonatology, Children’s Hospital Colorado
| | - Alyssa Goldberg
- Department of Pediatrics, University of Colorado Hospital, Section of Gastroenterology, Hepatology and Nutrition, Children’s Hospital Colorado
| | - Shikha S. Sundaram
- Department of Pediatrics, University of Colorado Hospital, Section of Gastroenterology, Hepatology and Nutrition, Children’s Hospital Colorado
| | - Lorna P. Browne
- Department of Radiology, University of Colorado Hospital, Section of Radiology, Children’s Hospital Colorado
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Diaz-Miron J, Reppucci ML, Weinman J, Kaizer A, Annam A, Orsborn J, Steward L, Wilson J, Bensard D. The use of ultrasound in establishing COVID-19 infection as part of a trauma evaluation. Emerg Radiol 2022; 29:227-234. [PMID: 34988751 PMCID: PMC8731214 DOI: 10.1007/s10140-021-02005-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
Purpose The use of lung ultrasound for diagnosis of COVID-19 has emerged during the pandemic as a beneficial diagnostic modality due to its rapid availability, bedside use, and lack of radiation. This study aimed to determine if routine ultrasound (US) imaging of the lungs of trauma patients with COVID-19 infections who undergo extended focused assessment with sonography for trauma (EFAST) correlates with computed tomography (CT) imaging and X-ray findings, as previously reported in other populations. Methods This was a prospective, observational feasibility study performed at two level 1 trauma centers. US, CT, and X-ray imaging were retrospectively reviewed by a surgical trainee and a board-certified radiologist to determine any correlation of imaging findings in patients with active COVID-19 infection. Results There were 53 patients with lung US images from EFAST available for evaluation and COVID-19 testing. The overall COVID-19 positivity rate was 7.5%. COVID-19 infection was accurately identified by one patient on US by the trainee, but there was a 15.1% false-positive rate for infection based on the radiologist examination. Conclusions Evaluation of the lung during EFAST cannot be used in the trauma setting to identify patients with active COVID-19 infection or to stratify patients as high or low risk of infection. This is likely due to differences in lung imaging technique and the presence of concomitant thoracic injury.
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Affiliation(s)
- Jose Diaz-Miron
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, B-323, Aurora, CO, 80045, USA.
| | - Marina L Reppucci
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, B-323, Aurora, CO, 80045, USA
| | - Jason Weinman
- Division of Pediatric Radiology, Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alexander Kaizer
- Center for Innovative Design and Analysis, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Aparna Annam
- Division of Pediatric Radiology, Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan Orsborn
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lauren Steward
- Division of Gastrointestinal, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Juliana Wilson
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Denis Bensard
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, B-323, Aurora, CO, 80045, USA
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Joshi A, Heller RE, Acharya PT, Milla SS, Annam A. Pediatric radiology and advocacy: a professional responsibility. Pediatr Radiol 2022; 52:1412-1419. [PMID: 35438329 PMCID: PMC9016121 DOI: 10.1007/s00247-022-05369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/04/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Aparna Joshi
- Section of Pediatric Radiology, C. S. Mott Children's Hospital, Department of Radiology, University of Michigan, Room 3-220, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4252, USA.
| | | | - Patricia T. Acharya
- Department of Radiology, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA USA
| | - Sarah S. Milla
- Department of Radiology, Children’s Hospital Colorado, Aurora, CO USA
| | - Aparna Annam
- Department of Radiology, Children’s Hospital Colorado, Aurora, CO USA
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Raborn J, Monroe E, Annam A, Ladd P, Young V, Lungren M, Temple M, Gunn A. Abstract No. 80 Inferior vena cava filter placement and retrieval in pediatric patients: a multicenter retrospective analysis. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Cahill AM, Annam A, Baskin KM, Caplin D, Cramer HR, Connolly B, Crowley J, Heran M, Himes EA, Hogan MJ, Josephs S, Pabon-Ramos W, Prajapati H, Shivaram G, Towbin R, Vaidya SS. Society of Interventional Radiology Quality Improvement Standards for Percutaneous Nephrostomy in the Pediatric Population. J Vasc Interv Radiol 2021; 32:146-149. [PMID: 33388108 DOI: 10.1016/j.jvir.2020.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- Anne Marie Cahill
- Department of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Aparna Annam
- Department of Radiology, University of Colorado, School of Medicine, Aurora, Colorado; Interventional Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - Kevin M Baskin
- Department of Interventional Radiology, Sharon Regional Medical Center, Hermitage, Pennsylvania
| | - Drew Caplin
- Division of Interventional Radiology, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Harry R Cramer
- Section of Inverventional Radiology, Coastal Vascular and Interventional, PLLC, Pensacola, Florida
| | - Bairbre Connolly
- Image Guided Therapy, Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - John Crowley
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Manraj Heran
- Pediatric Interventional Radiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Diagnostic and Therapeutic Neuroradiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Mark J Hogan
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shellie Josephs
- Department of Radiology, Stanford Medicine, Palo Alto, California
| | - Waleska Pabon-Ramos
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Hasmukh Prajapati
- Division of Interventional Radiology, Department of Pediatric Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Giridhar Shivaram
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Richard Towbin
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Sandeep S Vaidya
- Department of Interventional Radiology, University of Washington Medical Center, Seattle, Washington
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16
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Devane AM, Annam A, Brody L, Gunn AJ, Himes EA, Patel S, Tam AL, Dariushnia SR. Society of Interventional Radiology Quality Improvement Standards for Percutaneous Cholecystostomy and Percutaneous Transhepatic Biliary Interventions. J Vasc Interv Radiol 2020; 31:1849-1856. [PMID: 33011014 DOI: 10.1016/j.jvir.2020.07.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- A Michael Devane
- Department of Radiology, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, South Carolina.
| | - Aparna Annam
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado; Interventional Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - Lynn Brody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Gunn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Sheena Patel
- Society of Interventional Radiology, Fairfax, Virginia
| | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Sean R Dariushnia
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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17
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Abstract
Percutaneous renal biopsy is widely used for diagnosis, prognosis, and management of nephropathies. Complications may arise after renal biopsy, most commonly in the form of bleeding. Efforts should be taken to optimize modifiable risk factors such as hypertension, thrombocytopenia, and coagulopathy prior to the procedure. Unmodifiable risk factors such as poor renal function, gender, and underlying histologic diagnosis may be used to identify high-risk patients. Delayed presentation of bleeding complications is common, and close clinical follow-up is crucial.
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Affiliation(s)
- Kenaz Bakdash
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Kristofer M Schramm
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Aparna Annam
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Matthew Brown
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Kimi Kondo
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Jonathan D Lindquist
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
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18
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Krowchuk DP, Frieden IJ, Mancini AJ, Darrow DH, Blei F, Greene AK, Annam A, Baker CN, Frommelt PC, Hodak A, Pate BM, Pelletier JL, Sandrock D, Weinberg ST, Whelan MA. Clinical Practice Guideline for the Management of Infantile Hemangiomas. Pediatrics 2019. [PMID: 30584062 DOI: 10.1542/peds.2018-3475/37268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
Infantile hemangiomas (IHs) occur in as many as 5% of infants, making them the most common benign tumor of infancy. Most IHs are small, innocuous, self-resolving, and require no treatment. However, because of their size or location, a significant minority of IHs are potentially problematic. These include IHs that may cause permanent scarring and disfigurement (eg, facial IHs), hepatic or airway IHs, and IHs with the potential for functional impairment (eg, periorbital IHs), ulceration (that may cause pain or scarring), and associated underlying abnormalities (eg, intracranial and aortic arch vascular abnormalities accompanying a large facial IH). This clinical practice guideline for the management of IHs emphasizes several key concepts. It defines those IHs that are potentially higher risk and should prompt concern, and emphasizes increased vigilance, consideration of active treatment and, when appropriate, specialty consultation. It discusses the specific growth characteristics of IHs, that is, that the most rapid and significant growth occurs between 1 and 3 months of age and that growth is completed by 5 months of age in most cases. Because many IHs leave behind permanent skin changes, there is a window of opportunity to treat higher-risk IHs and optimize outcomes. Early intervention and/or referral (ideally by 1 month of age) is recommended for infants who have potentially problematic IHs. When systemic treatment is indicated, propranolol is the drug of choice at a dose of 2 to 3 mg/kg per day. Treatment typically is continued for at least 6 months and often is maintained until 12 months of age (occasionally longer). Topical timolol may be used to treat select small, thin, superficial IHs. Surgery and/or laser treatment are most useful for the treatment of residual skin changes after involution and, less commonly, may be considered earlier to treat some IHs.
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Affiliation(s)
- Daniel P Krowchuk
- Departments of Pediatrics and Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina;
| | - Ilona J Frieden
- Departments of Dermatology and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Anthony J Mancini
- Departments of Pediatrics and Dermatology, Feinberg School of Medicine, Northwestern University and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - David H Darrow
- Departments of Otolaryngology and Pediatrics, Eastern Virginia Medical School and Children's Hospital of the King's Daughters, Norfolk, Virginia
| | - Francine Blei
- Donald and Barbara Zucker School of Medicine, Northwell Health, New York City, New York
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Aparna Annam
- Department of Radiology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Cynthia N Baker
- Department of Pediatrics, Kaiser Permanente Medical Center, Los Angeles, California
| | - Peter C Frommelt
- Department of Pediatrics, Cardiology, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Amy Hodak
- American Board of Pediatrics, Chapel Hill, North Carolina
| | - Brian M Pate
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, Kansas
| | | | - Deborah Sandrock
- St Christopher's Hospital for Children and College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Stuart T Weinberg
- Departments of Biomedical Informatics and Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee; and
| | - Mary Anne Whelan
- College of Physicians and Surgeons, Columbia University, New York City, New York
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19
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Krowchuk DP, Frieden IJ, Mancini AJ, Darrow DH, Blei F, Greene AK, Annam A, Baker CN, Frommelt PC, Hodak A, Pate BM, Pelletier JL, Sandrock D, Weinberg ST, Whelan MA. Clinical Practice Guideline for the Management of Infantile Hemangiomas. Pediatrics 2019; 143:peds.2018-3475. [PMID: 30584062 DOI: 10.1542/peds.2018-3475] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Infantile hemangiomas (IHs) occur in as many as 5% of infants, making them the most common benign tumor of infancy. Most IHs are small, innocuous, self-resolving, and require no treatment. However, because of their size or location, a significant minority of IHs are potentially problematic. These include IHs that may cause permanent scarring and disfigurement (eg, facial IHs), hepatic or airway IHs, and IHs with the potential for functional impairment (eg, periorbital IHs), ulceration (that may cause pain or scarring), and associated underlying abnormalities (eg, intracranial and aortic arch vascular abnormalities accompanying a large facial IH). This clinical practice guideline for the management of IHs emphasizes several key concepts. It defines those IHs that are potentially higher risk and should prompt concern, and emphasizes increased vigilance, consideration of active treatment and, when appropriate, specialty consultation. It discusses the specific growth characteristics of IHs, that is, that the most rapid and significant growth occurs between 1 and 3 months of age and that growth is completed by 5 months of age in most cases. Because many IHs leave behind permanent skin changes, there is a window of opportunity to treat higher-risk IHs and optimize outcomes. Early intervention and/or referral (ideally by 1 month of age) is recommended for infants who have potentially problematic IHs. When systemic treatment is indicated, propranolol is the drug of choice at a dose of 2 to 3 mg/kg per day. Treatment typically is continued for at least 6 months and often is maintained until 12 months of age (occasionally longer). Topical timolol may be used to treat select small, thin, superficial IHs. Surgery and/or laser treatment are most useful for the treatment of residual skin changes after involution and, less commonly, may be considered earlier to treat some IHs.
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Affiliation(s)
- Daniel P Krowchuk
- Departments of Pediatrics and Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina;
| | - Ilona J Frieden
- Departments of Dermatology and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Anthony J Mancini
- Departments of Pediatrics and Dermatology, Feinberg School of Medicine, Northwestern University and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - David H Darrow
- Departments of Otolaryngology and Pediatrics, Eastern Virginia Medical School and Children's Hospital of the King's Daughters, Norfolk, Virginia
| | - Francine Blei
- Donald and Barbara Zucker School of Medicine, Northwell Health, New York City, New York
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Aparna Annam
- Department of Radiology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Cynthia N Baker
- Department of Pediatrics, Kaiser Permanente Medical Center, Los Angeles, California
| | - Peter C Frommelt
- Department of Pediatrics, Cardiology, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Amy Hodak
- American Board of Pediatrics, Chapel Hill, North Carolina
| | - Brian M Pate
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, Kansas
| | | | - Deborah Sandrock
- St Christopher's Hospital for Children and College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Stuart T Weinberg
- Departments of Biomedical Informatics and Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee; and
| | - Mary Anne Whelan
- College of Physicians and Surgeons, Columbia University, New York City, New York
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20
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Madsen HJ, Annam A, Harned R, Nakano TA, Larroque LO, Kulungowski AM. Symptom Resolution and Volumetric Reduction of Abdominal Lymphatic Malformations With Sclerotherapy. J Surg Res 2018; 233:256-261. [PMID: 30502256 DOI: 10.1016/j.jss.2018.07.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/20/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Lymphatic malformations (LMs) are congenital and arise from errors in vascular embryogenesis. LMs are categorized by cyst size as microcystic, macrocystic, or combined. Abdominal LMs are rare. Surgical resection of abdominal LMs has been the mainstay of therapy, but recurrence and morbidity are high. We sought to determine the effectiveness of sclerotherapy treatment for abdominal LM. METHODS A single-center, retrospective review from 2014 to 2018 was conducted evaluating pediatric patients with abdominal LM. RESULTS Ten patients were included, n = 9 had macrocystic LM and one patient had combined disease. The average age at first treatment was 6.8 y. The most common presenting symptoms were abdominal distention, pain, infection, and anemia. Preprocedural imaging was performed for all patients; median pretreatment volume was 1572.9 cm3 (range, 67.2-13,226.4). LMs were accessed using ultrasound guidance and injected with opacified doxycycline. Patients received a mean of 7.1 sclerotherapy injections. Complications included intraperitoneal doxycycline extravasation (n = 1), managed conservatively, and LM infection (n = 1), treated with intravenous antibiotics and drainage. One patient went on to surgical resection due to inability gain stable intracystic access; follow-up ultrasonography showed no recurrence. Postprocedural imaging was available in n = 8. Volume decreased by 96.7% after sclerotherapy. The median remaining volume was 0 cm3 (range, 0-599.7) (P = 0.016). Postsclerotherapy magnetic resonance imaging was obtained in n = 6, with complete resolution in 83.3%. All patients had resolution of presenting symptoms. Follow-up duration was 12.3 mo. CONCLUSIONS Initial results demonstrate that sclerotherapy is an effective and durable treatment for symptom resolution and volume reduction of abdominal LM.
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Affiliation(s)
- Helen J Madsen
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Division of Pediatric Surgery, Children's Hospital Colorado, Vascular Anomalies Center, Aurora, Colorado; Division of Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado.
| | - Aparna Annam
- Division of Pediatric Surgery, Children's Hospital Colorado, Vascular Anomalies Center, Aurora, Colorado; Division of Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado; Department of Radiology, Children's Hospital Colorado, Interventional Radiology, Aurora, Colorado
| | - Roger Harned
- Division of Pediatric Surgery, Children's Hospital Colorado, Vascular Anomalies Center, Aurora, Colorado; Division of Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado; Department of Radiology, Children's Hospital Colorado, Interventional Radiology, Aurora, Colorado
| | - Taizo A Nakano
- Division of Pediatric Surgery, Children's Hospital Colorado, Vascular Anomalies Center, Aurora, Colorado; Division of Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado; Department of Oncology, Children's Hospital Colorado, Center for Cancer and Blood Disorders, Aurora, Colorado
| | - Lauren O Larroque
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Division of Pediatric Surgery, Children's Hospital Colorado, Vascular Anomalies Center, Aurora, Colorado
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Division of Pediatric Surgery, Children's Hospital Colorado, Vascular Anomalies Center, Aurora, Colorado; Division of Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado
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21
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Abstract
Vascular malformations are classified primarily according to their flow characteristics, slow flow (lymphatic and venous) or fast flow (arteriovenous). They can occur anywhere in the body but have a unique presentation when affecting the female pelvis. With a detailed clinical history and the proper imaging studies, the correct diagnosis can be made and the best treatment can be initiated. Lymphatic and venous malformations are often treated with sclerotherapy while arteriovenous malformations usually require embolization. At times, surgical intervention of vascular malformations or medical management of lymphatic malformations has been implemented in a multidisciplinary approach to patient care. This review presents an overview of vascular malformations of the female pelvis, their clinical course, diagnostic studies, and treatment options.
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Affiliation(s)
- Aparna Annam
- Division of Interventional Radiology, Department of Radiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
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22
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DePopas EM, Veress LA, Ahmed F, Rausch CM, Annam A, Gupta R. Percutaneous thoracic duct intervention to treat plastic bronchitis related to Fontan palliation. Pediatr Pulmonol 2017; 52:E97-E101. [PMID: 28869334 DOI: 10.1002/ppul.23793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/31/2017] [Indexed: 12/31/2022]
Abstract
Plastic bronchitis is a life-threatening condition of airway obstructive cast formation. This pediatric case series from a high altitude center details the course of three patients after percutaneous thoracic duct interventions for refractory plastic bronchitis, with a follow-up interval of 3.5 years. In two patients, where cisterna chyli maceration (patients 2) or thoracic duct embolization (patient 3) was performed, a sustained clinical improvement is shown, with no subsequent cast recurrence. In patient 1, cisterna chyli maceration resulted in partial improvement. Herein, a favorable outcome is shown in pediatric patients with percutaneous thoracic duct interventions for plastic bronchitis at altitude.
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Affiliation(s)
- Eric M DePopas
- Department of Radiology, University of Colorado, Denver, Colorado
| | - Livia A Veress
- Department of Pediatric Pulmonology, University of Colorado, Denver, Colorado
| | - Farres Ahmed
- Department of Radiology, University of Colorado, Denver, Colorado
| | | | - Aparna Annam
- Department of Pediatric Radiology, Children's Hospital Colorado, Denver, Colorado
| | - Rajan Gupta
- Interventional Radiology, Colorado Permanente Medical Group, Denver, Colorado
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23
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Annam A, Munden MM, Mehollin-Ray AR, Schady D, Browne LP. Extratesticular masses in children: taking ultrasound beyond paratesticular rhabdomyosarcoma. Pediatr Radiol 2015; 45:1382-91. [PMID: 25786605 DOI: 10.1007/s00247-015-3316-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 01/12/2015] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
Abstract
Extratesticular cystic and solid scrotal masses are commonly encountered in pediatrics. The most common extratesticular malignancy is paratesticular rhabdomyosarcoma. The remainder of the common pathologies encountered -- appendage torsion, epididymitis and varicoceles -- are mostly benign. These frequently encountered benign lesions are confidently differentiated from paratesticular rhadbomyosarcoma using high-frequency scrotal sonography in combination with clinical features. Less commonly encountered extratesticular masses may not be as easily classified; however, these also have distinguishing features that can enable differentiation from malignancy. This review discusses the sonographic findings, and relevant clinical and pathological manifestations of the more unusual extratesticular masses encountered in two tertiary pediatric institutions during a 10-year period. While these extratesticular pathologies are encountered relatively infrequently, recognition of their manifestations enables appropriate management.
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Affiliation(s)
- Aparna Annam
- Department of Pediatric Radiology, Children's Hospital Colorado, 13123 East 16th Ave., Box 125, Aurora, CO, 80045, USA
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24
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Krishnamurthy R, Hernandez A, Kavuk S, Annam A, Pimpalwar S. Imaging the Central Conducting Lymphatics: Initial Experience with Dynamic MR Lymphangiography. Radiology 2015; 274:871-8. [DOI: 10.1148/radiol.14131399] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Affiliation(s)
- Aparna Annam
- Department of Pediatric Radiology, Children's Hospital of Colorado, Box 125, 13123 East 16th Ave., Aurora, CO, 80045, USA,
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26
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Pimpalwar S, Annam A, Chinnadurai P, Hernandez A. Imaging of the thoracic duct using C-arm CT lymphangiography (CTL) following ultrasound guided inguinal nodal injection in children with right to left shunts. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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27
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Pimpalwar S, Annam A, Chinnadurai P, Hernandez A. Percutaneous trans-splenic embolization of roux limb varices in children with chronic portal vein occlusion (PVO) post orthotopic liver transplant (OLT). J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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28
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Krishnamurthy R, Hernandez A, Kavuk S, Annam A, Pimpalwar S. Dynamic magnetic resonance lymphangiography (MRL): a new technique to image the central conducting lymphatics (CCL). J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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29
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Festini E, Madge S, Nedi S, Ballarin S, Anbar R, Annam A, Armoni Y, Boulanger L, Bregnballe V, Crews B, De Vries J, Douthit J, Elworthy S, Erwander I, Ferguson M, Green M, Hennessey R, Heydendael M, Jokinen L, Kerbrat M, Laraya-Cuasay L, Lomas E, McMullen A, Nation K, Peterson M, Tolomeo M. 409 Procedural pain in children with Cystic Fibrosis: an international survey on the methods used by CF centres to prevent and reduce it. J Cyst Fibros 2006. [DOI: 10.1016/s1569-1993(06)80349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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